Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201005229 | |
N | 225XH1200X | Occupational Therapist - Hand | 5201005229 | |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 5201005229 | MI |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201005229 |
NPI | 1043777865 |
---|---|
Provider Name | Lisa Marie Buddemeier |
First Address | Portage, MI 49024-1232 |
Second Address | Portage, MI 49024-1232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 08/04/2019 |